Obamacare is dead; long live Obamacare. Or maybe not. Early in 2015, thanks to incessant conservative teeth gnashing, the Supreme Court will once again gird up its robe-covered loins to make a major ruling on Barack Obama’s signature law.
The plaintiffs in the upcoming King v. Burwell case claim that, according to the Affordable Care Act’s (ACA) statute, the IRS exceeded the limits of its regulatory powers by allowing for both state-run AND federal exchanges. It’s a classic right-wing “states’ rights” argument. 22 states have already balked on setting up exchanges, and conservatives are betting that weeding out the federal cash that’s picking up the slack in red states will undermine the entire structure of Obamacare. No matter that blocking federal subsidies could yank insurance coverage away from upwards of 11.8 million people: after all, are there no prisons, no poorhouses?!
So while the current band of anarchist GOP homunculi certainly out-crazy their forefathers, the ideological struggle over universal health care is hardly new. In fact, it remains the most crucial dividing issue between the two major American political parties. In an era where both parties respond to the demands of oligarchs, liberals view equality (via equal access to health care) as necessary to expanding freedom; while conservatives believe that freedom can only be achieved via inequality. Indeed, as Corey Robin observes in The Reactionary Mind: Conservatism from Edmund Burke to Sarah Palin, “[w]hat the conservative sees and dislikes in equality…is not a threat to freedom but its extension. For in that extension, he sees a loss of his own freedom.”*
I’ll explain further. But first, let’s recap of the fight for universal health care in America.
Back in 1912, Teddy Roosevelt proposed the idea of social insurance. But business interests and Roosevelt’s conservative opponents opposed any government intrusion in healthcare, an area where the private sector could reap huge profits. In 1933, as part of the New Deal, President Franklin Delano Roosevelt declared healthcare to be a right. Again, however, the American Medical Association (AMA) and Republicans fought back hard. In 1935, FDR succeeded in passing the Social Security Act, but only after a fight with right-wingers who, in their 1937 “Conservative Manifesto,” denounced the entire New Deal as creeping socialism.
Conservatives continued to oppose universal healthcare into the mid-twentieth century. Harry Truman’s plan to expand Social Security into a universal insurance program fell prey to Republican congressional victories in 1947. In 1965, Lyndon Johnson signed into law Medicare, a now-cherished single-payer insurance program for the elderly. Wingnuts of the time, such as then bad-actor Ronald Reagan — in a famous ad for the AMA — demagogued Medicare as a threat to freedom itself. In the face of these right-wing assaults, universal health coverage remained elusive.
Then, in the gritty 1970s, conservatism began its near forty-year political dominance in the U.S. In a process described in detail by two recent studies: Jacob Hacker and Paul Pierson’s Winner-Take-All Politics and Eric Alterman and Kevin Mattson’s The Cause: The Fight for American Liberalism from Franklin Roosevelt to Barack Obama, the Democratic Party shifted rightward in order to keep pace with the country’s conservative political swing. Liberals faced the increased lobbying clout of a politically empowered and (thanks to globalization) geographically mobile business community that aligned itself with the GOP. Moreover, organized labor — liberalism’s traditional source of political muscle — declined in influence and power amid increasing global competition and a hostile domestic political environment. The Democratic Party had been the only institutional voice for liberalism, and when it lost its ability to speak to American pocketbooks, it scrambled to compete for the campaign funds that business groups poured into the GOP’s plutocrat-preferencing coffers. In short, beginning in the 1970s, Democrats became more like Republicans — even to the point of embracing the individual insurance mandate that originated as a paternalistic conservative scheme to force alleged freeloaders to buy health insurance under penalty of fine.
The Democrats’ rightward shift notwithstanding, they still support universal healthcare. Republicans, as the voice of an unhinged conservatism, oppose it. Thus, we arrive at the current schism over Obamacare. Despite Democrats’ and Republicans’ political resemblance, conservatives still oppose universal healthcare because they oppose the notion of equality. Corey Robin writes that conservatives see in equality the extension of freedom from the few to the many, which threatens the ruling power of the few, who tend to be conservatives.*
This is why America’s elite — banks, insurance companies, and the medical lobbies — rallied behind their GOP toadies (and corporate Democrats) in the fight to quash Obamacare. Universal health care ensures financial protection for workers in an economy where labor power has been destroyed and the business community domineers over the political system like the feudal lords of old. With universal health care, Americans become freer, more mobile, more secure individuals who are no longer beholden to their ever-more-powerful and miserly employers. The latter is a status preferred by conservatives who perceive any agency on the part of the lower orders as a threat to “natural” ruling hierarchies.
By contrast, liberals believe that individual freedom can only be achieved when people control their own destiny, free from the dictates of both the state and private interests. This is why, despite the Democrats’ rightward turn, they’ve nonetheless retained a belief in universal health care’s ability to expand freedom. The right wing cannot allow liberals to connect universal health care to individual freedom. Hence, the GOP’s kamikaze-style opposition to Obamacare.
Universal healthcare, then, remains the most important divide between the two modern American political parties. Conservatives know that if the ramparts fall on this issue, a political wedge they’ve exploited for a century will be destroyed. Thus, when looney toons like former Minnesota Rep. Michelle Bachmann claim that Obamacare will “get Americans addicted to the crack cocaine of dependency on more government health care,” they aren’t expressing concern for the health of average people. Rather, wingnuts know that if Obamacare helps Americans avoid health-related financial ruin, then conservatives will lose the ideological debate over whether universal health care expands or constrains individual freedom. This is why they’re obsessed with destroying Obamacare: the power of the ruling class demands such a feverish last stand.
* See Corey Robin, The Reactionary Mind: Conservatism from Edmund Burke to Sarah Palin (New York: Oxford University Press, 2011), 8.